Single-inhaler fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol plus umeclidinium using two inhalers for chronic obstructive pulmonary disease: A randomized non-inferiority study

Background: Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg has been shown to improve lung function and health status, and reduce exacerbations, versus budesonide/formoterol in patients with chronic obstructive pulmonary disease (COPD). We evaluated the non-inferiority of single-inhaler FF/UMEC/VI versus FF/VI + UMEC using two inhalers. Methods: Eligible patients with COPD (aged ≥40 years; ≥1 moderate/severe exacerbation in the 12 months before screening) were randomized (1:1; stratified by the number of long-acting bronchodilators [0, 1 or 2] per day during run-in) to receive 24-week FF/UMEC/VI 100/62.5/25 μg and placebo or FF/VI 100/25 μg + UMEC 62.5 μg; all treatments/placebo were delivered using the ELLIPTA inhaler once-daily in the morning. Primary endpoint: change from baseline in trough forced expiratory volume in 1 s (FEV1) at Week 24. The non-inferiority margin for the lower 95% confidence limit was set at − 50 mL. Results: A total of 1055 patients (844 [80%] of whom were enrolled on combination maintenance therapy) were randomized to receive FF/UMEC/VI (n = 527) or FF/VI + UMEC (n = 528). Mean change from baseline in trough FEV1 at Week 24 was 113 mL (95% CI 91, 135) for FF/UMEC/VI and 95 mL (95% CI 72, 117) for FF/VI + UMEC; the between-treatment difference of 18 mL (95% CI -13, 50) confirmed FF/UMEC/VI’s was considered non-inferior to FF/ VI + UMEC. At Week 24, the proportion of responders based on St George’s Respiratory Questionnaire Total score was 50% (FF/UMEC/VI) and 51% (FF/VI + UMEC); the proportion of responders based on the Transitional Dyspnea Index focal score was similar (56% both groups). A similar proportion of patients experienced a moderate/severe exacerbation in the FF/UMEC/VI (24%) and FF/VI + UMEC (27%) groups; the hazard ratio for time to first moderate/ severe exacerbation with FF/UMEC/VI versus FF/VI + UMEC was 0.87 (95% CI 0.68, 1.12). The incidence of adverse events was comparable in both groups (48%); the incidence of serious adverse events was 10% (FF/UMEC/VI) and 11% (FF/VI + UMEC). Conclusions: Single-inhaler triple therapy (FF/UMEC/VI) is non-inferior to two inhalers (FF/VI + UMEC) on trough FEV1 change from baseline at 24 weeks. Results were similar on all other measures of efficacy, health-related quality of life, and safety. Trial registration: GSK study CTT200812; ClinicalTrials.gov NCT02729051 (submitted 31 March 2016)

Superfluid density and Berezinskii-Kosterlitz-Thouless transition of a spin-orbit coupled Fulde-Ferrell superfluid

We theoretically investigate the superfluid density and Berezinskii-Kosterlitz-Thouless (BKT) transition of a two-dimensional Rashba spin-orbit coupled atomic Fermi gas with both in-plane and out-of-plane Zeeman fields. It was recently predicted that, by tuning the two Zeeman fields, the system may exhibit different exotic Fulde-Ferrell (FF) superfluid phases, including the gapped FF, gapless FF, gapless topological FF and gapped topological FF states. Due to the FF paring, we show that the superfluid density (tensor) of the system becomes anisotropic. When an in-plane Zeeman field is applied along the \textit{x}-direction, the tensor component along the \textit{y}-direction $n_{s,yy}$ is generally larger than $n_{s,xx}$ in most parameter space. At zero temperature, there is always a discontinuity jump in $n_{s,xx}$ as the system evolves from a gapped FF into a gapless FF state. With increasing temperature, such a jump is gradually washed out. The critical BKT temperature has been calculated as functions of the spin-orbit coupling strength, interatomic interaction strength, in-plane and out-of-plane Zeeman fields. We predict that the novel FF superfluid phases have a significant critical BKT temperature, typically at the order of $0.1T_{F}$, where $T_{F}$ is the Fermi degenerate temperature. Therefore, their observation is within the reach of current experimental techniques in cold-atom laboratories.Comment: 11 pages, 7 figure

Comparison of PUFA profiles in the blood and in follicular fluid and its association with follicular dynamics after PGF2α induced luteolysis in dairy cows

The objectives of the present study were to examine the fatty acid (FA) profiles in serum and in the follicular fluid (FF) and the association between polyunsaturated fatty acid level (PUFA) and follicular growth dynamics following induced luteolysis in dairy cows. A total of 29 dairy cows (CL>25mm, follicle approximate to 15mm) at d0 (start of the experiment) were submitted to ultrasound guided transvaginal follicular aspiration for FF collection from the largest follicle and were injected with 500 mu g of cloprostenol. The cows were subdivided into Group A1 (n=11) and Group A2 (n=8) resuming follicular growth either from a secondary follicle less than or larger than 8.5mm, respectively, present at the moment of aspiration and Group A0 (n=10) not resuming follicular growth. Follicular development was monitored daily by ultrasonography until the next dominant follicle reached approximate to 15mm and was subsequently punctured in Group A1 and A2 (d1). Serum and FF samples for FA determination were taken at d0 from all cows and at d1 in Group A1 and A2. No differences were observed between the FA profile in serum nor in FF between sampling days. Regarding the PUFA levels, the serum linoleic acid (C18:2n6) levels at d0 and d1 were significantly higher than in FF, while alpha linolenic acid (C18:3n3) was lower in the serum than in FF, both at d0 and d1. At d0, a tendency for negative correlation between serum and the FF C18:2n6 with subsequent daily follicular growth rate was observed, while, at d1 there was a strong negative correlation between the serum C18:2n6 and daily growth rate (r=-0.71; p=0.0006). The present study revealed similarities of the FA profiles in the serum and in the FF and association between serum and FF PUFA content with the follicular dynamics after induced luteolysis